Anthem Precertification Program Expands for Medical Specialty Drugs

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Jul 12, 2017

​Specialty drugs are one of the key drivers of increasing health care costs today, with costs expected
to continue their upward trend in the coming years. These specialty drugs are expensive and used to
treat rare and complicated conditions like hepatitis C, rheumatoid arthritis, multiple sclerosis,
hemophilia and cancer.

Some specialty drug treatments can be taken orally, which members can manage themselves. Others
need to be infused, which requires a professional to administer. Because of this, these drugs may be
covered under a health plan’s pharmacy or medical benefit. To help control costs and achieve the
best outcome, it is important to have a specialty drug management strategy in place under both the
pharmacy and medical benefits.

As part of Anthem's ongoing efforts to manage these drug costs, they are expanding their precertification
program to include medical specialty edits. The expansion of Anthem's precertification program will allow
clients who currently have their precertification program to benefit from these enhancements. There
are two components to this expansion:

Coverage for select clinically equivalent agents over others where applicable:

ASO clients in California who have Anthem's precertification program managed by
Anthem

Dose, frequency and duration for certain agents, including drugs:

​Coverage for safe and effective dosing and drug administration for the member

Available beginning September 1, 2017 for: Individual, fully insured and ASO clients who have Anthem's precertification program managed by AIM

Expansion of Anthem's precertification program allows them to manage medical specialty drugs using the
same strategies employed under the pharmacy benefit. This results in consistent, comprehensive
clinical reviews.

For questions, please ​contact a member of your B&P Sales Team - 888.722.3373.